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Food Preparation Requirements (includes packaging and handling): <br />Yes No <br />11. Hand washing is required immediately prior to handling foods and after engaging in <br />any activity that contaminates the hands such as after using the toilet, coughing or ❑ <br />sneezing, eating or smoking.11l���/ <br />12. Warm water, hand soap and clean towels are available for hand washing. p(J ❑ <br />13. All food ingredients used in the CFO products are from an approved source. /7RI;/// ❑ <br />14. Potable water shall be used for hand washing, ware washing and as an ingredient. ❑l <br />15. Is your water source a private well? /❑\ V <br />a. If YES, have you completed testing for bacteria and nitrate? ❑ ❑ <br />16. Is your water source a public water system or community services district? tyl ❑ <br />a. If YES, what is the name of the system or district? <br />l� Yes No <br />During the preparation, packaging or handling of CFO products: <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or ❑ <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. ddd <br />18. Infants, small children, or pets are excluded from the kitchen. t{{t ❑ <br />19. Smoking is excluded. /py ❑ <br />20. Any person with a contagious illness shall refrain from work in the CFO. /] ❑ <br />Labeling Requirements: <br />Yes No <br />21. A copy of the label has been submitted to this Department for review and approval. ❑ <br />22. 1 have attached a sample label. ❑ <br />V <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 <br />(Gatto), as it pertains to a "Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must <br />nobly San Joaquin County Environmental Health Department of any Intended changes to the above statement. <br />Cottage <br />Checklist completed and submitted by: <br />M`�ioi 1.41�Os Ili 12 a22 <br />Print Namd Date <br />EHO 16-26 12/272012 2 CFO CLASS A CHECKLIST <br />